Pelvic mass Flashcards
non gynae causes for pelvic mass bowel
constipation - commonest
caecal cancer
appendix abscess
diverticular abscess
non gynae causes for pelvic mass other
urinary retention, pelvic kidney
retroperitoneal tumour
lymphomas
gynae causes for pelvic mass
uterine
tubal and para tubal
ovarian
uterine causes for pelvic mass
pregnancy
fibroids - commonest
endometrial cancer - but usually presents early with PMB before mass
cervical cancer - late presentation with renal failure/bleeding/pain before mass is seen
what are uterine fibroids
age
size
very common
leiomyosarcomas very rare
>40s
can be few cm to bigger and multiple
types of fibroids
submucosal suserous intracavity intramural pedunculated
presentation of fibroids
may be asymp/incidental finding
menhorrhagia
pelvic mass
pain/tenderness but this if pregnant or menopause
pressure symptoms - increased frequency and nocturia
who are fibroids common in
afro carribean population
investigations for suspected fibroids
Hb if heavy bleeding
USS - usually dx
MRI for more precise localisation
treatment of fibroids
hysterectomy - if family complete
myomectomy
uterine artery embolisation
hysteroscopic resection
tubal swellings
ectopic preg - usually ruptures before becoming a pelvic mass
hydrosalpinx - fluid blocking tube - often longstanding/incidental
pyosalpinx - pus blocking tube - acute/inflam
paratubal cysts - usually small and incidental - embryological remnants
ovarian massess
tumours
functional cysts
endometriosis cysts
what are functional cysts related to
size
rx
sx
follicular cysts/luteal cysts
rarely >5cm dm
usually resolve spontaneously
often asymp/incidental finding
may be menstrual disturbance
may bleed or rupture and cause pain
what can endometriosis cause
what is assoc with
px
can cause blood filled cysts
severe dysmehnorrhagia, premenstrual pain, dyspareunia, sub fertility
tender mass with nodularity behind uterus
asympt till large choc cysts which may rupture
ovarian tumours that rise form the surface epithelium
serous mucinous endometrioid clear cell brenner
ovarian tumours that arise from germ cells
benign cystic teratoma (dermoid cyst) - commonest
malignant germ cell tumours - v v v rare
ovarian tumours arising from stroma
granulosa cells - secrete oestrogens - percasious puberty
theca/lydig cells severe androgens - androgenisation
fibroma - meigs syndrome
what can malignant germ cells produce
HCG or AFP
types of dermoid cyst
totipotential
teeth, sebaceous materia, hair
thyroid tissue -> thyrotoxicosis
granulosa cell tumours
oestrogen producing
precocious puberty, PMB
thecal tumours
androgen producing
hirsutism -> virilisation
fibromas
meigs syndrome with benign fibroma and pleural effusion and ascites
secondary mets in ovary
breast
pancreas
stomach
GI primaries
presentation of ovarian cancer
mass, swelling, pressure symptoms
early peritoneal spread - malignancy ascites with protein exudate
insidious symptoms
often referred
referred ovarian cancer
heart burn/indigestion early satiety weight loss/anorexia bloating pressure symptoms (esp bladder) change of bowel habit SOB/pleural effusion leg oedema/DVT
genetics and ovarian cancer
BRACA1/2
lynch syndrome
risk factors for ovarian cancer
what protects
age
nulliparity
FH
OCP
ix for ovarian cancer
hx and exam
CA 125, CEA markers
US - nature
CT - assessing spread
CA125 raised when
when more useful
in 80% of cancers endometriosis peritonitis/infection preg pancreatitis ascites other malignancies
for follow up rather than dx
CEA raised when
primary function
moderately elevated in ovarian cancer esp in mucinous tumours
exclude mets from GI primary
USS finding of ovarian cancer
complex mass with solid and cystic areas multi loculated thick separations associated ascites bilateral disease
what is RMI
menopausal status x CA125 x USS score
treatment of ovarian cyst/mass
removal or drainage if benign
removal of ovaries and uterus
acute presentation of pelvic mass
cyst - rupture, haemorrhage, torsion and ischaemia
fibroid degeneration - red, compromised blood supply, seen in pregnancy or in peri menopause
examination for pelvic mass
anaemia cachexia chest breast nodes legs abdo speculum/bimanual
describing the mass
size - cms or weeks gestation consistency surface tenderness mobility relation to uterus pouch of douglas
ix of pelvic mass
Hb WCC/CRP if suspected inflam Biochem esp serum albumin tumour markers - CA125, CEA, HCG, AFP CXR USS MRI for fibroids/uterine mass CT - suspected ovarian cancer
